Valve Selection

[Jkm7]

My Mass General surgeon, where they are participating in the percutaneous valve study, felt very confident by the time I would have to worry about a possible valve replacement, my bovine tissue would be replaced percutaneously. Even had I not felt confident in what he said in that regard, I still would have opted for tissue valve.

For ME, it was /is the right valve. I fully know it is not for everyone. It is one of those really hard choices we have to make and there is no wrong choice. Whichever you choose is the right one for you.

 

[haggis basher]

Hi All
I had a 'tissue' valve implanted last August (2011). I was 71 age. It is now 9 months after surgery, and all
I take is half an asprin. I have built up my running to the extent that I can jog for nearly an hour. I am looking forward to at least another 10 - 12 years from this valve, and to get back into 'long-distance' running.
Being honest,this topic will go on for ever, as really there is 'no' ideal solution. Weigh up the 'pro and cons', and go with it.
Good luck
Brian

 

[Lynlw]

My surgeon specifically warned me not to count on percutaneous valve replacement. It is still quite awhile before it will be approved for "normal" or "low" risk patients. In addition, he indicated the valve is of smaller diameter than one replaced the "normal" way. This does not make a difference for the current "high risk" patients undergoing the trial, but could for someone else.

Actually for a FIRST valve surgery, not to replace an older tissue valve, the valve AREA is larger than a valve that is sewn inplace, since the leaflets are sewn onto a thin stent and the valve doesnt need a large sewing ring that a traditional valve needs that basically takes up space.

 

[Hayley]

Hi everyone. I am new to this forum and it has been a help, I read through all of these comments and stories and it's helped me make up my mind a bit. I'm 18 and going for a mitral valve replacement soon. My surgeon told me the mechanical should last the rest of my life so I immediately thought that would be the best option. The coumadin is not a huge problem for me. Then I hear some people it makes a ticking noise and I could never live with that. But from what you all said it doesn't sound like it's a huge issue. I'm leaning more towards the mechanical now more than ever! I think I could handle it.
I also don't want surgery every 10 or so years. :thumbd:

 

[Lynlw]

Hi everyone. I am new to this forum and it has been a help, I read through all of these comments and stories and it's helped me make up my mind a bit. I'm 18 and going for a mitral valve replacement soon. My surgeon told me the mechanical should last the rest of my life so I immediately thought that would be the best option. The coumadin is not a huge problem for me. Then I hear some people it makes a ticking noise and I could never live with that. But from what you all said it doesn't sound like it's a huge issue. I'm leaning more towards the mechanical now more than ever! I think I could handle it.
I also don't want surgery every 10 or so years. :thumbd:

Hi welcome, Sorry to hear you need surgery at your age. I'm thinking your a female, sorry if im wrong , but When you were discussing valve choice, did your surgeon discuss if you wanted to have any children, (of your own, get pregnant)? That is one of the main reasons why women in childbearing years get tissue valves, since altho it IS possible to carry a baby/give birth to a healthy baby with a mech valve and coumadin it usually isnt reccoemended, especially if it is a mitral valve that needs replaced.Since mech valves and coumadin can be dangerosu to bit the mother and baby

 

[Hayley]

Yes, I am a female. Sorry, I should have specified! As for children, I am only 18 and childbirth has always freaked me out and I have always said I'd adopt kids, but obviously my mind might change as I grow older, though. My surgeon says that he's had a lot of patients who have had children on coumadin successfully, he says it just takes a lot of planning and timing.

 

[Lynlw]

Yes, I am a female. Sorry, I should have specified! As for children, I am only 18 and childbirth has always freaked me out and I have always said I'd adopt kids, but obviously my mind might change as I grow older, though. My surgeon says that he's had a lot of patients who have had children on coumadin successfully, he says it just takes a lot of planning and timing.

I would probably talk to other doctors, or ask the surgeon IF they had mitral valves or WHY they were on coumain, since for the most part surgeons dont follow their patients long term. I would also search here to read what others who planned well went thru with their pregnnancies on Coumadin or even were told by their doctors

One member you could do a search for is willow that should bring up a few of the pregnancy on coumadin threads if your interested,

http://www.valvereplacement.org/for...Willow-s-Pregnancy-after-MVR&highlight=willow

 

[Hayley]

I will add that to my list of questions to ask my surgeon. I will also search that on this forum. Thank you.

 

[RBCola]

Yes, I am a female. Sorry, I should have specified! As for children, I am only 18 and childbirth has always freaked me out and I have always said I'd adopt kids, but obviously my mind might change as I grow older, though. My surgeon says that he's had a lot of patients who have had children on coumadin successfully, he says it just takes a lot of planning and timing.

Just so everyone here knows, the reason for not wanting women on coumadin is two parts. First, the higher bleeding associated during/after pregnancy with coumadin. The second, and most important, is that coumadin is teratogenic, meaning that it can cause birth defects because it crosses the placenta. The incidence of birth defects estimated around 5% of women on warfarin.

What the surgeon/hematologist may want to do is place you on heparin or a low-molecular weight heparin (ie lovenox) during your pregnancy instead of warfarin. Heparin and lovenox do not cross the placenta. Here is an article discussing all these issues.

http://archinte.jamanetwork.com/article.aspx?volume=163&issue=6&page=694

 

[Lynlw]

Just so everyone here knows, the reason for not wanting women on coumadin is two parts. First, the higher bleeding associated during/after pregnancy with coumadin. The second, and most important, is that coumadin is teratogenic, meaning that it can cause birth defects because it crosses the placenta. The incidence of birth defects estimated around 5% of women on warfarin.

What the surgeon/hematologist may want to do is place you on heparin or a low-molecular weight heparin (ie lovenox) during your pregnancy instead of warfarin. Heparin and lovenox do not cross the placenta. Here is an article discussing all these issues.

http://archinte.jamanetwork.com/article.aspx?volume=163&issue=6&page=694

Besides the increased Bleeds, clotting is a big concern, especially right at the end of pregnancy

 

[Hayley]

This sounds like so much information. I really don't know if I want kids yet, or to have my own, or anything. I thinking I should go with a tissue valve for now and by the time it needs to be replaced I would have my mind made up. Say, if I have a tissue valve and have had my children, could I then switch to a mechanical valve after? I'm going to ask my surgeon the same thing.

 

[kfay]

This sounds like so much information. I really don't know if I want kids yet, or to have my own, or anything. I thinking I should go with a tissue valve for now and by the time it needs to be replaced I would have my mind made up. Say, if I have a tissue valve and have had my children, could I then switch to a mechanical valve after? I'm going to ask my surgeon the same thing.

Yes, you should be able to switch to mechanical at that time. I think it is wise of you to go tissue first time around if you even slightly think you may want to have children. Best of luck to you.

 

[Hayley]

I was leaning towards mechanical so much and I was sure I was going to go with it, but my mind still wasn't at ease. But I think I'm going to go with tissue for the first 10 years at least. Ahh, I feel better now and think this is the right decision, I will absolutely talk with my surgeon. Thanks to everyone.

 

[Lynlw]

I was leaning towards mechanical so much and I was sure I was going to go with it, but my mind still wasn't at ease. But I think I'm going to go with tissue for the first 10 years at least. Ahh, I feel better now and think this is the right decision, I will absolutely talk with my surgeon. Thanks to everyone.

Please talk to all your doctors befre you decide, maybe there is some other reason they are reccomending mech since we're not doctors. I just didnt want you to choose a mech valve and then later find out they dont reccomend you get pregnant with your valve. That happened to someone else here, whose doctors said it wouldnt be a problem BEFORE her surgery..I thought it was sad.

 

[Hayley]

I will for sure talk about it with my doctors. My surgeon actually never recommended anything, he told me to think about what I wanted and at the next visit he could tell me his opinion if I wanted. He had already told me about the children stuff. That is horrible. Why wouldn't they tell her that?

 

[Lynlw]

I will for sure talk about it with my doctors. My surgeon actually never recommended anything, he told me to think about what I wanted and at the next visit he could tell me his opinion if I wanted. He had already told me about the children stuff. That is horrible. Why wouldn't they tell her that?

Haley, Do you go to a Cardiologist/clinic that specializes in Adult with Congenital Heart Defects? They should have doctors that specialise in pregnancy on their team. If you aren't maybe it would be good to get opinions from one.

 

[Hayley]

I'm not sure. I was just recently transferred over to the adult side and have only met with my cardiologist and surgeon once. My leaky valve is causes by a rare type of vasculitis so, I think my doctor knows more about the vasculitis than other heart defects. I will ask next time I'm there.

 

[Tell-Tale Heart]

Better late than never, I thought I'd chime in. I've had two successful OHS, one tissue (human valve) 20 years ago and then, almost a month ago, mechanical (On-X). After both surgeries I recovered to function normally (without lifting) within 2-3 weeks.
With the tissue valve, I recovered and my life continued without restrictions or medication for 20 years.
The BIG difference with the mechanical valve is balancing the coumedin and dietary considerations. No, it doesn't change how I feel physically, but mentally INR is always in your mind. Everytime you eat you wonder. You worry when your INR is out of range. You go out and would like a 2nd glass of wine, but know you shouldn't. And between tests, you worry that you should be testing. And yes, they say to be consistent with your diet, but I hate eating the same stuff every week.
I chose the mechanical valve because I didn't want to face another possible OHS in the future. But given the limited discomfort and recovery of OHS, I'd choose tissue now that I've lived with both valve types.
Just one lady's opinion.......

 

[Roberta]

Better late than never, I thought I'd chime in. I've had two successful OHS, one tissue (human valve) 20 years ago and then, almost a month ago, mechanical (On-X). After both surgeries I recovered to function normally (without lifting) within 2-3 weeks.
With the tissue valve, I recovered and my life continued without restrictions or medication for 20 years.
The BIG difference with the mechanical valve is balancing the coumedin and dietary considerations. No, it doesn't change how I feel physically, but mentally INR is always in your mind. Everytime you eat you wonder. You worry when your INR is out of range. You go out and would like a 2nd glass of wine, but know you shouldn't. And between tests, you worry that you should be testing. And yes, they say to be consistent with your diet, but I hate eating the same stuff every week.
I chose the mechanical valve because I didn't want to face another possible OHS in the future. But given the limited discomfort and recovery of OHS, I'd choose tissue now that I've lived with both valve types.
Just one lady's opinion.......

Thank you for sharing this opinion, Pat. It is nice to see the full gamut of opinions and feedback regarding 2 surgeries and what your choice would be re: valves.

 

[Hayley]

Hello again. I met with my surgeon a few days ago and his personal opinion was that I would be better off with a mechanical valve. He told me that I probably won't be able to hear it, it's mostly the aortic valves that you can hear, and since mine is the mitral valve I shouldn't be able to hear it. So now, once again, I'm leaning to mechanical valve. He told me I could keep thinking about it and I don't have to sign the paper until the pre-op clinic. Offical date of surgery is July 30th, by the way.